Chemotherapy First: Making the Decision
- Most women with ovarian cancer get some combination of surgery and chemotherapy
- Surgery is typically given first
- Chemotherapy before surgery may be better for women who are older, who have other health conditions, or who have a large tumor
- Chemo can help to shrink the tumor, making surgery easier to perform
The decision is very individualized based on a woman's unique situation. Having chemotherapy first, called neoadjuvant chemotherapy, may be a better option for women who are older, whose tumor is too large to remove entirely with debulking surgery, or who have any underlying diseases that would make major surgery too risky, says Dr. Michael Ulm, gynecologic oncologist at West Cancer Center in Memphis, Tennessee.
What Neoadjuvant Chemotherapy Treatment Looks Like
Read MoreHelping You Feel Better
Getting chemotherapy first doesn't just prepare your body for surgery. It also helps to relieve uncomfortable cancer symptoms."A lot of times these patients have symptoms like nausea and vomiting, and weight loss," Dr. Ulm says. "Neoadjuvant chemotherapy can make those symptoms better."
If you've been picking at your food, chemo can also help you eat well again. A nutritious diet is important to keep up your strength for surgery. "[Chemotherapy] can make their nutritional status better because it decreases the disease on the inside of the abdomen and allows the bowels to function better," he adds.
Are You Ready for Surgery?
After three to four cycles of chemotherapy, your doctor will do a computed tomography (CT) scan to see whether your cancer has shrunk enough to remove completely with surgery.
If your cancer has receded enough, you'll be ready to move ahead with a debulking procedure. That's typically followed by another three or four rounds of combination chemotherapy.
Dr. Ulm says about 80% of his patients respond well to neoadjuvant chemotherapy, but that means about one in five don't see their tumors shrink on treatment. When that happens, it requires a thoughtful discussion about next steps, which might involve trying a different drug combination.
Choosing a First Treatment in the Time of COVID-19
The COVID-19 pandemic has changed the way doctors decide on a first treatment for women with ovarian cancer. Rather than simply look at a woman's health or whether her cancer can be completely removed when deciding to give chemotherapy before surgery, they consider the risks of treating her at a hospital where there could be coronavirus patients.
"When the coronavirus came around, we met as a group in early March and just decided everybody that was stage three or four cancer would get neoadjuvant chemotherapy instead of primary debulking," Dr. Ulm says. The hope was that, by the end of three chemo cycles, the situation would improve and there would be fewer people with COVID-19 in the hospital. "Our primary goal, starting in March and even now, is trying to keep the patients out of the hospital as much as we possibly can to decrease their contact with COVID."
If you’re concerned about getting surgery first, whether because of your age, your health, or the coronavirus pandemic, ask your doctor whether you can start with chemotherapy, and what that might mean for your prognosis.
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